Provider Demographics
NPI:1265526628
Name:MEDEL, LISA CRAIGS (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CRAIGS
Last Name:MEDEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 205TH AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8275
Mailing Address - Country:US
Mailing Address - Phone:253-863-6378
Mailing Address - Fax:253-863-6429
Practice Address - Street 1:19102 SR 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8449
Practice Address - Country:US
Practice Address - Phone:253-863-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30327111N00000X
WACH60464407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor